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PERMITT~E NAME/ADDRESS (/Mid. frWyNsw/faaam dD,C..wU NAME :Y: ': )'-. T~~ .trT ..t. r-~u•r, ADDRESS ~ L :.. 1 F ~ `. . r ..:' ~ ~ , F`•';L,£Y07^ ~G it ti5 FACILITY LOCATION :~!: ~DRRIS :. ~.';L~-r, '." ?.4L a.T'NY NATIONAL POLIUTMT DISCNMOE ELIMINATIQN SY9TEM lIYPOE$l DISCNARGE MONITORING REPORT (DMRI !7-rei n-rel PERMIT NUMBER DISCHMGE NUMBER MONITORING PERIOD YEAR MO DAY YEAR MO DAY FROM ~ ~ . % .. TO '' .: "~ ' ~ !1671/ l77-731 /74151 !16771 /76-191 1303/1 ^^v^TC ~- y' r^ Form Approved. OMB-No.• 2040-0004• Approval, axgirea 05-3~1-98 ,..t v^ ^I•-r'-'1 ,cam ~-~ ::: •: NOTE: Raed Instrucdone belore completlnp this lorm. PARAMETER !3 Grd On/yl QUANTITY OR LOADING !4 Grd On/Yl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE lab-531 /546/1 l38-d51 !4653 !54611 EX ~r TYPE l3I-37/ yS MA AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e7-s.T~ !64581 /69-701 ]I~'(' SAMPLE ": r:C##^ r#b ~ • rrt:Y r:t Y. Q O~ ~ 'I ( ~ a~ '7 / Qa8 ^r.iL BECOgcRll"LF MEASUREMENT J I ~ ~:/'~'±0 1 0 ^ PERMIT #0#9L:A~ ,^•aGr#X~ g4e>alrtztr 1~ry ^~'I+Il?'I' NRc?r./ :??L°. 'F[•CIFNT ;ur)SS gAT.IIF REQUIREMENT ¢~}} ~nDA Syr n~TLp Rry ~ ~ v-/T ~~ M/)1VTH ~IL4r'Ra PDTS+ITIPLLY SAMPLE np#### '.`-,".#### 4##!t'<4' 1q~ ( _:. ~DZPF.D-- -- - -- -- - MEASUREMENT --------- - ------- --- -- ~_ -~~~ - -- --- - '.11~1 1 0 0 ~ .PERMIT #G•'S •'#X ###R#=:r ~ I.`^C- ##>r'~Yr# RP,F7 HT Px'FORT _I~C@/ ~ iRAB ':'L(;EgT G!?DSc gFLJ`~ REQUIREMENT c:;## i0D1 A4^ nAT~LT rz '4G/L t70RTN ,G.~?kf POTF4TT:Li.Y SAMPLE .•?;` .C~~Trw.p r;e.`- Y:': M ~ ~ l Q ~01 ( ,q~ ICA$ :~ I'.i a J L V j•: 1 MEASUREMENT f W h i O it-11~h )- C ) PERMIT r;: •XvL#f. .•}-t%Lt#O r! #':~ t:,.tt.~t:~ 0.~~3 ^.1T 'i~FF/ .RAP FFLIIEH~ ;H" ~' YRI,UF REQUIREMENT ¢YY:a? Qpnq (n- ~A_-L.q YY „7 T. "!^NTP ~ASoANF.S-, '.I'LL - ~ SAMPLE MEASUREMENT .;:t#~# ..~#G~I -.."'+'•'::+ p. 3a ~ . ( i~) ~ 3o ~1 (~1(D ,C;~q Epp ,I ~• / y Llll3 i C' 0 PERMIT '%C#3C# .~`#;=R>~ CCQIk"Y: ya~(}a'^ a'^pnp^ c veLr '.Rac, :Cr'LU2yT ,;RD'i5 VALL1` REQUIREMENT t,<:L•':S ~/1pP 7TI(, nP'T,Y Mt( ~~/T :.,wa jN C(11pOjT OR ^' ' SAMPLE MEASUREMENT 1u~E~f~QQ Q ~ "1V` O rZ$~ ( 03) ...-. .....; ..,..:; ..; #.;.....~ u 1I~ 1'~tA~ ~F .<:; 'rnE~+r~~:vr PLAy I I 1 f J =CiO~~:~ 1 0 0 PERMIT F.EPD~T REPORT :M#;kY.r r~-'•~al>;rri '"#t~i`=';: E~'K".•. ^f5T4`: '.T''LUf 9T GROSS '11, L. 11r ~REQUIREMEN7 3001! ~V DAILF rx 7G9 ~~~?='-` )T I, 4~iD ;A?Ai.' SAMPLE G9 ~'F ."-~: ( 9u) ,.r#^il:'r fw;Z~A~; i~~.r. ~. r. 1 / I = ; ] L MEASUREMENT ~ /30 ~ ~L jJ0`. i 1 () 'I ~ PERMIT S+S: YJ ~SF# ~ } I P. S=L `y;k~ifili :::#^.IwR C'k +: {i$::' .`.~;:` t P^r7•Y TS')A. f. "'PLOENT .;R7~ ~ '.r+L7F REQUIREMENT I95T kA"t y0=0 SAMPLE MEASUREMENT PERMIT REQUIREMENT NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTI AM FA FY UNDER PENALTY OF UW TNAT I HAVE PERSONALLY E%AMINED MD MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASFD ON i TELEPHONE DATE MY INQUIRY OF THOSE INDIVIDUALS IMM WIATELY RESPONSIBLE FOR ~ F?ichard I~I~~S OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ ~~~ ' ` TRUE. ACCURATE MD COMRETE. I AM AWME TNAT THERE ME SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING I ~~ ~~"~ 97~ ~7D-~7~2 LD LS SE r 3Y cnvironmentel ~" ~r)u , THE POSSIBILITY OF RNE MD IMPNSONMENT. SEE 1B U.S.C. f 1001 MD ]] BIONATURE OF PRINCIPAL EXECUTIVE U.S.C. 1 1 ]I a. nVIYIe1r uMY eMY .be,hs wlrY hcAN~ aAr W ro S IO,OOD AREA TYPED OR PRINTED .nexms.inun imprism~rt a/Mrwwn emenM. rWe WrA/ OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Reference s// sfrecnmsnrs nets! ....'i ;4NETr L;'IL" "~': "`'i> :R'i: L'rt ~L`'' ;JLI~3 (L. ~'-, r]E~ SOD•Y ^erV Tn <e ~n_vyr ~;~_ur i,o ~..Tr c•O ;tiT T. .~.u/~i~EL)• S-~ •. •~r ~'. j lr F~1 I.I $'iC ~i fir' ('Uf10c .'T.7i T'q°?"'~~'"~• r.TT. . ^pr],-^_~_cCC cr; rTr rnT ^/r P-' 7~ EPA Form 3320-1 (08.95) Previous editions may be used. IREPL.ACES EPA FORM T~0 WHICH MAY NOT BE USED.) ~ ^,t ~ ~ / O ,I r ~I n ~ _ y ^ ~ ,~ PAGE -, OF